A recent projection from the US Centers for Disease Control and Prevention suggested that drug overdose deaths should decrease to approximately 68 000 in 2018, from 71 000 deaths in 2017, the first reported projected decline since 1990 (thought to be largely attributed reduced deaths associated with prescription opioids). Even so, deaths associated with synthetic opioids – mostly fentanyl – seem to continue on an  increasing trajectory. Recent research addressing the near-real-time results of urine drug testing (UDT) for methamphetamine, cocaine, and heroin, with and without illicit fentanyl, have been published in the JAMA. The research was a cross-sectional study of UDT results from 1 050 000 unique patient urine specimens submitted for testing by health care professionals as part of routine care from January 1, 2013, to October 31, 2019. (definitive UDT results performed using liquid chromatography–tandem mass spectrometry). Specimens were randomly selected from the entire study period with equal specimen numbers per year, but specimens from patients reported to have been prescribed methamphetamine, cocaine, or fentanyl were excluded.The median (interquartile range) age of patients was 45 (20-70) years, with patients from all states of the nation included. From 2013 to 2019, the + rate for methamphetamine increased from 1.43% (95% CI, 1.37%-1.49%) to 8.39% (95% CI, 8.25%-8.53%), a 486.71% increase (P < .001); the cocaine + rate increased from 4.09% (95% CI, 3.99%-4.19%) to 4.94% (95% CI, 4.83%-5.05%), a 20.78% increase (P < .001); the heroin + rate increased from 1.41% (95% CI, 1.35%-1.48%) to 1.99% (95% CI, 1.92%-2.06%), a 41.13% increase (P < .001); and the fentanyl + rate increased from 1.09% (95% CI, 1.04%-1.15%) to 4.72% (95% CI, 4.62%-4.83%), a 333.03% increase (P < .001). Positive tests for cocaine and heroin peaked in 2016, unlike the case for methamphetamine and fentanyl. For those testing positive for fentanyl, the positive test rates of co-occurring methamphetamine, cocaine, and heroin have increased markedly in the period spanning 2013 – 2019). The researchers suggest identification of these trends would support development of targeted interventions to reduce the impact of drug abuse on public health. Read the details of the study, published in JAMA Open Network, here.